|
4.7.7 ELECTRICAL PERMIT AItLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION
<br /> PROJECT ADDRESS: I IQL.0 ( i-f h . .---,,,-,e--_ L- , .....{
<br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE OF BUILDING: Cf-v-w vi-c ,-,.` Z.e,��s. \ — t c r. a`
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK: $ ;t 0 00
<br /> NUMBER OF DEVICES (if low voltage): l
<br /> FIRE ALARM? DYES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> (DESCRIPTION OF WORK: i A.b-�-c,,lv l c') (--k 0 rc �t� f';,;1� v2," iu,..0 c- e'e'l?C C:4•/'c..� I
<br /> ( L' (_
<br /> - r 1 ia.-0(
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 13€_.r Ve Ori c.C, TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1+0(21 s 0--e`C-. c.jam_ Gt..; ^ Si., `j,J `I ''s-C.- 4oc' �u,
<br /> CITY AJC'—c-..-Ick _ j _(, STATE LA),A ZIP 676‘6)62
<br /> OWNER PHONE: QL,- 76, 3--: 6 6,., OWNER EMAIL:
<br /> CONTRACTOR NAME: (3\Sz.r, L vk-s-.c
<br /> CONTRACTOR ADDRESS: STREET Z.,j_S- U,:i c,S h;yx7 1-cin ,4,-,e-- .S -1i::,---- A'27.,l
<br /> CITY `��--e4-1,.t- STATE ZIP q ,0 3._2_.
<br /> CONTRACTOR PHONE:c2 5-3 ----F-?-7,q. --(9G S CONTRACTOR EMAIL: ;>{-;�,JC. ,...,e_(,4?-c1--1-„L,,,-,.....4---
<br /> CONTRACTOR
<br /> -,.... -.CONTRACTOR LIC.#(REQUIRED): _ a e CITIOF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> �iL.��i`)�� t 3 l; l_- 041,10/-
<br /> PRIMARY
<br /> 41p102PRIMARY CONTACT: 0 OWNER IONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Z e„,.,___/6/0,--
<br /> JO S\--kV\. C--et c 'v\i-)- 67 CONTACT EMAIL:i. , h1/4,iv' ry 15e,-)',-I :_c_ ,;L.,, ILZ.(—
<br /> AGREEMENT:I hereby certify that I have redd and examined this application and know the sad to be true and torrect. All provisions of laws and ordinances governing this type
<br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> $12.62,
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> 6:��, ,ate Z X14/ 1-7 E 110 " Oq1
<br /> /4„
<br /> er/Autho d Agent Signature Date (Revised 9/23/2016) /
<br />
|